Self Neglect

What is self-neglect?

a lack of self-care to an extent that it threatens personal health and safety
neglecting to care for one's personal hygiene, health or surroundings
the inability to avoid harm as a result of self-neglect
failure to seek help or access services to meet health and social care needs
the inability or unwillingness to manage one's personal affairs

What causes self-neglect?

It is not always possible to establish a root cause for self-neglecting behaviours. Self-neglect can be a result of:

a person's brain injury, dementia or other mental disorder
obsessive compulsive disorder or hoarding disorder
physical illness which has an effect on abilities, energy levels, attention span, organisational skills or motivation
reduced motivation as a side effect of medication
addictions
traumatic life change

Supporting adults who are, or at risk of, self-neglecting

The Care Act 2014 recognises self-neglect as a category or abuse and neglect which means that safeguarding duties apply where the adult has care and support needs and is at risk of self-neglect which they are unable to protect themselves from (due to their care and support needs).

The adult often struggles to recognise the risks they are living with. They may lack mental capacity in relation to the care needs and in some more complex and high risk circumstances it may be necessary to consider using the Mental Capacity Act 2005 and Best Interests frameworks to provide vital care and support.

When developing an approach it is important to try and understand the individual and what may be driving their behaviour. There are some general pointers for an effective approach:

Multi-agency – work with partners to ensure the right approach for each individual
Person centred – respect the views and the perspective of the individual, listen to them and work towards the outcomes they want
Acceptance – good risk management may be the best achievable outcome, it may not be possible to change the person’s lifestyle or behaviour
Analytical – it may be possible to identify underlying causes that help to address the issue
Non-judgemental – it isn’t helpful for practitioners to make judgements about cleanliness or lifestyle; everyone is different
Empathy – it is difficult to empathise with behaviours we cannot understand, but it is helpful to try
Patience and time – short interventions are unlikely to be successful, practitioners should be enabled to take a long-term approach
Trust – try to build trust and agree small steps
Reassurance – the person may fear losing control, it is important to allay such fears
Bargaining – making agreements to achieve progress can be helpful but it is important that this approach remains respectful
Exploring alternatives – fear of change may be an issue so explaining that there are alternative ways forward may encourage the person to engage
Always go back – regular, encouraging engagement and gentle persistence may help with progress and risk management

Practical tasks

Risk assessment – have effective, multi-agency approaches to assessing and monitoring risk
Assess capacity – ensure staff are competent in applying the Mental Capacity Act in cases of self-neglect
Mental health assessment – it may, in a minority of cases, be appropriate to refer an individual for Mental Health Assessment
Signpost – with a multi-agency approach people can be signposted to effective sources of support
Contact family – with the person’s consent, try to engage family or friends to provide additional support
Decluttering and cleaning services – where a person cannot face the scale of the task but is willing to make progress, offer to provide practical help
Utilise local partners – those who may be able to help include the RSPCA, the fire service, environmental health, housing, voluntary organisations
Occupational therapy assessment – physical limitations that result in self-neglect can be addressed
Help with property management and repairs – people may benefit from help to arrange much needed maintenance to their home
Peer support – others who self-neglect may be able to assist with advice, understanding and insight
Counselling and therapies – some individuals may be helped by counselling or other therapies. Cognitive behaviour therapy, for example, may help people with obsessive compulsive disorder, hoarding disorder or addictions

Multi-Agency Risk Management Meetings (MARMM)

If the risks related to an adult's self neglect are increasing at an unmanaged level, where significant self-neglect concerns are apparent, it is essential that a multi-agency risk management approach is used to try and address the adult's needs and risks.

The agency(s)/individuals(s) identifying self-neglect must consider whether a multi-agency risk management meeting (MARMM) needs to be convened. The MARMM must involve all the relevant agencies, the adult themselves (wherever possible) and other members of the adult's network as appropriate.

The duties and powers within The Care Act, Mental Health Act and the Mental Capacity Act etc, must be explored and the outcome recorded. However, you don't need to await the outcome of the assessment(s) to convene a MARMM.

It is important to identify a lead agency that will be informed of the adult's primary need. For example, this may be adult social care who assume the lead agency role, where there are identified needs under the Care Act 2014.

MARMM Notification

In April 2025, the BCSSP introduced a MARMM Notification process.

The notification process is simply a Microsoft Forms document with the adult name, DoB, address and information about the MARMM. We are requesting the lead agency use this notification process after the first MARMM has been conveyed.

There are several reasons the BCSSP are asking for you to complete the notification. Some of these being:

For assurance around MARMM’s being undertaking
To support better pathways/interplay between MARMM, Best Interest (under the Mental Capacity Act) and Safeguarding enquires (under the Care Act)
To support demand, capacity and resource discussions, and to aid the BCSSP in exploring how we can better support the MARMM process. Which include:
- What strategic support and oversite can be offered now, for MARMM’s that are ongoing and identify high risks
- What capacity/ resource can be provided in future to support MARMM’s that are ongoing and identify high risks

To notify, simply click here and provide the information and click submit.